Annals of hepatology最新文献

{"title":"Portopulmonary hypertension: an integrated approach to diagnosis, risk stratification, and management.","authors":"Jesús Donate, Susana Del Prado, Andrés Tenes, María Jesús Del Cerro, Agustín Albillos, Luis Téllez","doi":"10.1016/j.aohep.2026.102466","DOIUrl":"10.1016/j.aohep.2026.102466","url":null,"abstract":"<p><p>Portopulmonary hypertension (PoPH) is a complex and underrecognized form of pulmonary arterial hypertension arising in the setting of portal hypertension, in which outcomes are driven by the interplay between pulmonary vascular disease and liver dysfunction. Despite advances in hemodynamic definitions and targeted therapies, PoPH remains associated with significant morbidity and mortality, largely due to delayed diagnosis, challenges in risk stratification, and the absence of disease-specific management strategies. Recent insights support a paradigm shift from a purely hemodynamic view toward an integrated model encompassing pulmonary vascular load, right ventricular adaptation and hepatic reserve. This multidimensional framework has important implications for screening, prognostic assessment and therapeutic decision-making, particularly in the context of liver transplantation, where treatment is increasingly aimed at achieving transplant eligibility. In this review, we provide a comprehensive and clinically oriented overview of PoPH, integrating current evidence on pathophysiology, diagnosis, risk stratification and management. We highlight key limitations of existing approaches, discuss emerging therapeutic strategies and propose a conceptual framework to guide clinical practice and future research in this challenging condition.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102466"},"PeriodicalIF":6.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of non-selective beta blockers in the treatment of acute-on-chronic liver failure: a systematic review and meta-analysis.","authors":"Yiqi Shi, Quanfeng Zhang, Xianfu Hu, Jiangang Shen, Pi Liu","doi":"10.1016/j.aohep.2026.102457","DOIUrl":"10.1016/j.aohep.2026.102457","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Non-selective beta blockers (NSBBs) are beneficial for people with chronic liver diseases by reducing portal pressure. However, the benefit of NSBB treatment in patients with acute-on-chronic liver failure (ACLF) remains controversial. This systematic review and meta-analysis aimed to explore the efficacy of NSBBs in ACLF patients.</p><p><strong>Materials and methods: </strong>A systematic search was conducted in PubMed, EMBASE, Web of Science, and Cochrane Library databases up to December 5, 2025. The quality of the included studies was assessed using the revised Cochrane Collaboration Risk of Bias Tool for randomized controlled trials and the Newcastle-Ottawa scale for cohort studies. Effect estimates were reported as risk ratio (RR) with 95% confidence interval (CI). The primary outcome was overall mortality, while secondary outcomes were 1-month, 3-month, and 12-month mortality.</p><p><strong>Results: </strong>Of the 2007 articles identified, six articles were included. The pooled mortality was 48.9% in the NSBB group compared to 67.4% in the non-NSBB group (RR = 0.81, 95% CI: 0.73-0.91, p<0.01, I² = 27%). One-month mortality (RR = 0.66, 95%CI: 0.52-0.84; p<0.01), 3-month mortality (RR = 0.87, 95%CI: 0.77-0.97; p = 0.01), and 12-month mortality (RR = 0.84, 95%CI: 0.75-0.93; p<0.01) in the NSBB group were significantly lower than those in the non-NSBB group.</p><p><strong>Conclusions: </strong>This meta-analysis demonstrates that NSBBs are associated with improvement in the short term (1-month) and 1-year survival outcomes in patients with ACLF. However, further studies with more evidence are required to support these findings.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102457"},"PeriodicalIF":6.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond portal pressure reduction: Interpreting the survival benefit of statin add-on therapy in portal hypertension.","authors":"Yun Liao, Lihua Feng","doi":"10.1016/j.aohep.2026.102462","DOIUrl":"10.1016/j.aohep.2026.102462","url":null,"abstract":"","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102462"},"PeriodicalIF":6.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial resistance in invasive infections among patients with cirrhosis in Latin America: A multicenter registry.","authors":"Emilse Daniela Diaz Lobo, Gonzalo Gómez Perdiguero, Astrid Smud, María Dolores Murga, Ana Palazzo, Esteban González Ballerga, Ilse Sorena Pardo Ivirico, María Daniela Pérez, Lorena Notari, Josefina Pages, Manuel Mendizabal, Camila María Briz, Agustín Di Santo, Julia Brutti, Brenda Osso Sánchez, Margarita Anders, Pablo Calzetta, Alina Zerega, Angelo Z Mattos, Laura R Maboni, Maximiliano Castro, Fernando Cairo, Lucia Navarro, Martin Elizondo, Gisela Gualano, Maria Laura Garrido, Diego Hernan Giunta, Diego Arufe, Marcelo Valverde, Agostina Romero, Natalie Vilcinskas, Jorge Garavito Rentería, Javier Diaz Ferrer, Rommel Zambrano Huailla, Laura Tenorio Castillo, Karla Aquino Vargas, Esther Veramendi Shult, Melisa Dirchowlf, Jesica Tomatis, Adrián Gadano, Sebastián Marciano","doi":"10.1016/j.aohep.2026.102461","DOIUrl":"10.1016/j.aohep.2026.102461","url":null,"abstract":"","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102461"},"PeriodicalIF":6.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopy timing in managing acute esophagogastric variceal bleeding: a multicenter retrospective study.","authors":"Xinhui Li, Chunying Wang, Qun Li, Yuchen Lu, Wenbo Li, Minghui Wang, Yueyue Li, Yong Chen, Shuang Zhao, Qianqian Dong, Feifei Fan, Jing Wang, Xiaofeng Liu","doi":"10.1016/j.aohep.2026.102459","DOIUrl":"10.1016/j.aohep.2026.102459","url":null,"abstract":"<p><strong>Background: </strong>Patients suffering from acute esophagogastric variceal bleeding (AEGVB) frequently face unfavorable prognoses. Although endoscopy is the preferred intervention for AEGVB, the optimal timing for its administration to enhance patient outcomes remains a subject of ongoing debate.</p><p><strong>Methods: </strong>This study encompassed patients with cirrhosis who presented with AEGVB and received endoscopic treatment at three major tertiary hospitals in Shandong Province, China, from January 2017 to July 2024. Participants were stratified based on the time interval from hospital admission to endoscopic intervention (<12 h vs. ≥12 h; <24 h vs. ≥24 h; <48 h vs. ≥48 h; <72 h vs. ≥72 h). Propensity score matching (PSM) was utilized in a 1:1 ratio for each group. Subgroup analyses were performed based on patients' hematemesis status, Child-Pugh classification, and Model for End-Stage Liver Disease (MELD) score. The primary outcomes assessed included overall post-endoscopic rebleeding, 5-day rebleeding, 6-week rebleeding, rebleeding beyond 180 days, in-hospital mortality, and 6-week mortality. Furthermore, a multivariable Cox proportional hazards regression model was employed to identify risk factors for rebleeding.</p><p><strong>Results: </strong>Overall, 1125 patients who underwent endoscopic intervention for AEGVB were included. Prior to PSM, the group undergoing endoscopy within 12 h exhibited a significantly higher in-hospital mortality rate compared to the group undergoing endoscopy after 12 h (3.3%vs. 0.5%, P = 0.010). Post-PSM analysis revealed no significant differences between the two groups regarding in-hospital and 6-week mortality, overall post-endoscopic rebleeding, 5-day rebleeding, 6-week rebleeding, and rebleeding occurring beyond 180 days. In a subgroup analysis of patients presenting with hematemesis, those in the <24-hour group demonstrated a significantly higher incidence of overall post-endoscopic rebleeding (50.4%vs. 37.9%, P = 0.015) and rebleeding beyond 180 days post-treatment (29.9%vs. 19.3%, P = 0.014) compared to the ≥24 h group. Additionally, in the subgroup analysis of patients classified as Child-Pugh class B, the <24-hour group showed a significantly elevated rate of overall post-endoscopic rebleeding compared to the ≥24-hour group (50.0%vs. 38.2%, P = 0.026). This rate was also significantly higher in the <72-hour group compared to the ≥72-hour group (44.8%vs. 35.1%, P = 0.018). Notably, the incidence of rebleeding beyond 180 days post-endoscopic therapy was higher in the <72-hour group compared to the ≥72-hour group (25.2%vs. 17.7%, P = 0.029). Multivariate Cox regression analysis indicated that the timing of endoscopic therapy was not an independent risk factor for rebleeding.</p><p><strong>Conclusions: </strong>In conclusion, for patients with AEGVB who can tolerate endoscopy, early endoscopic intervention may not enhance the overall prognosis.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102459"},"PeriodicalIF":6.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the preclinical therapeutic landscape of cirrhotic portal hypertension: a systematic evidence map.","authors":"Sergi Guixé-Muntet, Anabel Fernández-Iglesias, Verónica Arreaza-Gil, Jordi Gracia-Sancho","doi":"10.1016/j.aohep.2026.102463","DOIUrl":"10.1016/j.aohep.2026.102463","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Portal hypertension has a limited pharmacological armamentarium despite decades of preclinical therapeutic research. We mapped the experimental architecture of this literature, independently of reported treatment efficacy.</p><p><strong>Materials and methods: </strong>PubMed/MEDLINE was searched from inception to March 31, 2026. Two independent title-and-abstract screening procedures identified 833 records retained by at least one screen; 540 formed a concordant core retained by both. Records were classified using a prespecified taxonomy of therapeutic strategy, intervention modality, animal model, species, sex, treatment schedule and reporting features. Global counts included all records; variable-specific distributions used available-case denominators. Treatment effects were not extracted.</p><p><strong>Results: </strong>Among records with classifiable mechanisms (n=709), vasoactive/neurohumoral (29.1%), NO-cGMP/endothelial (23.8%) and antifibrotic/HSC-extracellular-matrix strategies (20.0%) represented 72.9%. Among records reporting the relevant variable, rats accounted for 82.7% (677/819), males only for 85.9% (548/638), and CCl₄, bile-duct ligation/cholestatic models and thioacetamide for 45.2%, 30.3% and 10.6% (n=568), respectively. Randomization and blinding were identifiable in indexed information for 5.3% and 0.1% of all records. Principal distributions were preserved in the concordant core.</p><p><strong>Conclusions: </strong>Preclinical portal-hypertension research has generated mechanistic diversity on a narrow experimental foundation. Broader use of both sexes, etiologically diverse models, repeated dosing, rigorous design and complementary human-based platforms may strengthen translation.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102463"},"PeriodicalIF":6.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric considerations in HCC imaging and survivorship surveillance: response to Diaz Telli et al.","authors":"Yan Huang, Na Li","doi":"10.1016/j.aohep.2026.102448","DOIUrl":"10.1016/j.aohep.2026.102448","url":null,"abstract":"","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102448"},"PeriodicalIF":6.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EP547 (MRGPRX4 inverse agonist) for cholestatic pruritus due to primary biliary cholangitis or primary sclerosing cholangitis: Results from the phase 2 randomized, placebo-controlled PACIFIC study.","authors":"Cynthia Levy, David Jones, Gideon M Hirschfield, Shirley Dehn, John Hemming, Christian Weyer, Nan Nan, Andreas E Kremer","doi":"10.1016/j.aohep.2026.102449","DOIUrl":"10.1016/j.aohep.2026.102449","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>MRGPRX4, a chemosensory Mas-related G protein-coupled receptor activated by bile acids, has been implicated in the pathogenesis of cholestatic pruritus, a frequent and burdensome symptom in patients with primary biliary or sclerosing cholangitis (PBC/PSC). The phase 2 PACIFIC study investigated EP547, a MRGPRX4 inverse agonist, in patients with moderate-to-severe cholestatic pruritus.</p><p><strong>Patients and methods: </strong>Patients with PBC or PSC and a mean daily Worst Itch Numerical Rating Scale (WI-NRS) ≥4 were randomized 1:1 to once-daily oral 100 mg EP547 or placebo during a 6-week double-blind, placebo-controlled (DBPC) period. All patients then received EP547 in a 6-week open-label extension period. The primary endpoint was the change from baseline (CFB) in WI-NRS at Week 6. Secondary endpoints included the 5-D Itch Scale, the Patient Global Impression of Severity, the Patient Global Impression of Change, and safety and tolerability.</p><p><strong>Results: </strong>Sixty-one patients (PBC, n = 44; PSC, n = 17; median [range] age, 54.0 [21-77] years; female, 78.7%) received EP547 (n = 31) or placebo (n = 30). No substantial improvement was observed with EP547 versus placebo in WI-NRS scores at Week 6 (least squares mean [SE] CFB, -1.8 [0.4] vs -2.2 [0.4]). No secondary efficacy endpoints were met. EP547 was generally well tolerated, with no grade ≥3 treatment-emergent adverse events (TEAEs) reported in the DBPC period and no dose interruptions or treatment discontinuations due to TEAEs throughout the study.</p><p><strong>Conclusions: </strong>Results from the PACIFIC study suggest that mechanisms other than MRGPRX4 activation are responsible for pruritus in patients with PBC or PSC.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102449"},"PeriodicalIF":6.2,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149056884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to: Coronary artery disease after liver transplantation: The need for enhanced risk assessment and expanded considerations.","authors":"Christian Lewinter, Ying Shang","doi":"10.1016/j.aohep.2026.102451","DOIUrl":"10.1016/j.aohep.2026.102451","url":null,"abstract":"","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102451"},"PeriodicalIF":6.2,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149056920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond FIB-4-VCTE agreement: an imaging-triggered pathway for fibrosis screening in MASLD.","authors":"Tong Xu, Tianhuan Yang","doi":"10.1016/j.aohep.2026.102452","DOIUrl":"10.1016/j.aohep.2026.102452","url":null,"abstract":"","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102452"},"PeriodicalIF":6.2,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149057070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}